AIM To study the role of middle ear risk index (MERI) score, nasal pathology and Eustachian tube f u n c t i o n i n p r e d i c t i n g t h e o u t c o m e o f tympanoplasty. METHODOLOGY Patients of age group 5-60 years both male and female with diagnosis of CSOM, planned for tympanoplasty with or without mastoidectomy were taken in the study. Detailed history and examination of all patients fulfilling the inclusion criteria was done. Preop findings were observed and recorded. MERI scoring was obtained. The data collected pre operatively was assessed with surgical outcome based on graft uptake status and PTA. Post op follow up was done at 1.5 and 3 months. This data was evaluated and compared with pre op finding. RESULTS The overall success rate of tympanoplasty in the study was 86% based on graft uptake and 85% according to hearing benefit. The number of patients with graft up[take was higher among those with mild MERI score (87.5%) compared to those with moderate and severe MERI scores (83%). The graft uptake is lesser in patients with gross DNS & Eustachian tube dysfunction. Thus MERI is a helpful tool to ascertain the prognosis of tympanoplasty. CONCLUSION The study concludes that MERI score, DNE and ET function evaluation in patients with chronic otitis media are very useful methods in predicting the outcome of tympanoplasty. KEYWORDS Chronic otitis media, Middle ear risk index, Eustachian tube function, diagnostic nasal endoscopy, tympanoplasty outcome